NICE sets out guidelines for hypertension
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《英国医生杂志》
Combination drug treatment should be used to treat hypertension, recommends the National Institute for Clinical Excellence (NICE) in its latest guidelines on the diagnosis and management in primary care of essential hypertension in adults.
Previously patients would be given one antihypertensive drug, and if this failed to control their blood pressure adequately they would be taken off that drug and given an antihypertensive from another class.
However, after a review of the evidence base, the guidelines now recommend that patients be given a combination of antihypertensive drugs. Treatment should begin with a low dose diuretic of the thiazide type. blockers should be added as a second line of treatment, with a dihydropyridine calcium channel blocker being added as a third. In patients at a high risk of new onset diabetes, the second line treatment should be an angiotensin converting enzyme inhibitor, with a blocker being added only as a fourth line.
Dr Wendy Ross, a GP and member of the guideline development group, said, "Treating hypertension is the bread and butter work of general practice. GPs should pay attention to these guidelines because NICE has thoroughly reviewed the best evidence available to create this gold standard. We are not starting from scratch but aiming to improve the accuracy of diagnosis and quality of care for people with hypertension."
She indicated the potential benefits: "Better control will result in fewer strokes and heart attacks. And although it may seem that your initial workload will increase as a GP, ultimately you will see a long term decrease in your workload."
In addition GPs are advised to assess cardiovascular risk in patients with blood pressure persisting at 140/90 mm Hg or higher. Tests should include urine dipstick analysis, blood tests, and a 12 lead electrocardiogram.
Intervention is recommended for people with blood pressures of 160/100 mm Hg or more. Treatment should also be offered to patients with a cardiovascular risk of 20% or more.
"The aim of this guideline is to decrease morbidity and mortality resulting from cardiovascular diseases such as stroke, chronic renal failure, and coronary heart disease for which hypertension is a significant risk factor,"
said Andrew Dillon, NICE's chief executive.(Karen Hébert)
Previously patients would be given one antihypertensive drug, and if this failed to control their blood pressure adequately they would be taken off that drug and given an antihypertensive from another class.
However, after a review of the evidence base, the guidelines now recommend that patients be given a combination of antihypertensive drugs. Treatment should begin with a low dose diuretic of the thiazide type. blockers should be added as a second line of treatment, with a dihydropyridine calcium channel blocker being added as a third. In patients at a high risk of new onset diabetes, the second line treatment should be an angiotensin converting enzyme inhibitor, with a blocker being added only as a fourth line.
Dr Wendy Ross, a GP and member of the guideline development group, said, "Treating hypertension is the bread and butter work of general practice. GPs should pay attention to these guidelines because NICE has thoroughly reviewed the best evidence available to create this gold standard. We are not starting from scratch but aiming to improve the accuracy of diagnosis and quality of care for people with hypertension."
She indicated the potential benefits: "Better control will result in fewer strokes and heart attacks. And although it may seem that your initial workload will increase as a GP, ultimately you will see a long term decrease in your workload."
In addition GPs are advised to assess cardiovascular risk in patients with blood pressure persisting at 140/90 mm Hg or higher. Tests should include urine dipstick analysis, blood tests, and a 12 lead electrocardiogram.
Intervention is recommended for people with blood pressures of 160/100 mm Hg or more. Treatment should also be offered to patients with a cardiovascular risk of 20% or more.
"The aim of this guideline is to decrease morbidity and mortality resulting from cardiovascular diseases such as stroke, chronic renal failure, and coronary heart disease for which hypertension is a significant risk factor,"
said Andrew Dillon, NICE's chief executive.(Karen Hébert)